A Comment on Coronavirus Disease 2019 and the Hair.

Abstract

The novel viral pandemic coronavirus disease 2019 (COVID-19) has sparked uncertainties and controversies as to its origin, epidemiology, and natural course. In this situation, the medical disciplines strive to contribute to a better understanding of the disease with the best available evidence gained from the scientific method of observation and statistics. The study of the cutaneous manifestations of COVID-19 has evolved with the hope that they may be useful as markers for the disease, for prognostication, and further insights into the pathogenesis of the disease manifestations. With regard to the hair, clinicopathological correlations have remained hypothetic. Association of androgenetic alopecia (AGA) and gray hair with COVID-19 severity, COVID-19-associated postinfectious effluvium, scalp allodynia, and stress-induced telogen effluvium have been the objects of speculation. Further in-depth studies are warranted to establish whether COVID-19-associated hair loss is due to the systemic inflammation with fever, or whether the inflammation and/or severe acute respiratory syndrome coronavirus 2 may target the hair follicle. Meanwhile, dermatologic conditions have been investigated as cutaneous markers for elevated mortality risk, including AGA and graying. Ultimately, most have been scrutinized with regard to the accuracy and validity of the statistics and not been found to be convincing in identifying them as independent risk factors. We therefore challenge the proposal of the "Gabrin sign" as an eponym for AGA as a severity risk factor in COVID-19. Moreover, Dr. Frank Gabrin is rather to be remembered for his selfless and courageous service at the front lines of the pandemic than for the stigma of his alopecia.